关键词:
Globus Pallidus/surgery*
Humans
Microelectrodes*
Neurosurgical Procedures*
Stereotaxic Techniques/instrumentation*
摘要:
To the Editor: I read with great interest the article of Kirschman et al. (2) on the usefulness of microelectrode recording in refining the target for pallidotomy. The authors have performed a very meticulous study on how an analysis of microelectrode recording track locations contributed to refining the location of the pallidotomy lesion. The authors aimed at a starting target point “located 3 mm anterior to the midcommissural point, 20 to 22 mm lateral to the intercommissural line, and 4 to 10 mm ventral to the AC-PC plane” (2). This means that they aimed at the posterior and ventral areas of the globus pallidus. They write in the introductory section that “Postoperative magnetic resonance imaging (MRI) data were used to demonstrate the final lesion location” (2). In the Results section, they state that postoperative MRI showed that the “location of the lesion within the globus pallidus was confirmed” (2). However, the authors are careful to point out that “with the MRI technique used in this study, [they] cannot determine whether the lesion is within the GPi” (2). Upon studying the only MRI figure in this article (Fig. 2), showing an axial cut with a 1-day-old pallidotomy lesion, I was astonished to see that the lesion was at the level of the foramina of Monro: This lesion lay very dorsal and very anterior, compared with the previously defined target point. This lesion location does not correspond to the sensorimotor posteroventral pallidum aimed at, but rather, it lies in the anteromediodorsal pallidum, a target favored by Irving Cooper in the 1950s, when he performed chemopallidectomies (1). Several studies on primates and on humans have since shown that the anteromediodorsal pallidum is mainly involved in cognitive, not sensorimotor, circuitry (3). I am aware that a stereotactic radiofrequency lesion consists of a volume of tissue and that a single axial MRI slice does not reflect the whole rostrocaudal or dorsoventral extension of the lesion in the target are